The Role of Serum Interleukin 22 Levels in Predictingspontaneous bacterial peritonitis inpatientswith hepatitis C virus induced liverCirrhosis
Mohammed Ahmed Abd El waheb;
Abstract
Ascitic fluid infections are considered serious complications in cirrhotic patients with high morbidity and mortality.Early diagnosis of SBP along with prompt initiation of empiric antibiotic therapy have been considered crucial in overall patient’s survival .Hence, a diagnostic paracentesis with an appropriate ascitic fluid analysis is considered essential in all patients admitted to hospital with ascites prior to any therapy,to exclude causes of ascites other than cirrhosis and rule out SBP in cirrhosis .
However, despite the use of sensitive methods, ascites culture has been negative in as many as 60% of patients with clinicalmanifestations suggestive of SBP and increased ascites neutrophil count. In this regard, given that the crucial role of requiring prompt recognition and treatment, in all the available guidelines, diagnosis has been based on a fixed defined cut-off PMN count in the ascitic fluid with the greatest sensitivity is reached at a cut-off value of 250 PMN/mm3.
Nonetheless, in the emergency setting, performing ascitic fluid culture examination is time consuming and not always available indicating the need for easy to apply, rapid and reliable markers to predict diagnosis in patients with ascites.
Interleukin 22 (IL-22) was originally identified as an IL-10-related T cell-derived inducible factor (IL-TIF), belonging to IL-10 family. IL-22 mainly targets epithelial cells including hepatocytes, playing an important role in controlling bacterial infection, homeostasis, and tissue repair.
IL-22 is a well-documented antioxidant factor for hepatocytes via the upregulation of anti-oxidative genes (e.g., metallothioneins 1 and 2) . Finally, IL-22 has a potent antiapoptotic, anti-steatotic, antifungal , and antimicrobial effects .
In the cirrhotic liver,IL22 may be secreted to protect residual healthy livertissue. Assuming that IL-22 possesses hepatoprotectiveproperties in end-stage liver disease, IL-22 may be a relevantfactor for progression of liver cirrhosis and developmentof hepaticcomplications as spontaneous bacterial peritonitis (SBP) .
Aim:To evaluate the role of serum Interleukin-22levels in predicting spontaneous bacterial peritonitisin hepatitis C virus related liver disease.
Patients and Methods: This study was conducted on 60 patients from January 2014 to February 2015 admitted at the internal medicine department of Suez health insurance hospital suffering from Hepatitis C virus induced liver cirrhosis and ascitic fluid infection.
The patients were classified according to presence and/or sterility of ascitic fluid at time of admission into 3 groups:
Group 1:(combination group: typical culture positive SBP and culture negative SBP n=20) Then group1(combination group) was subdivided into:Group 1A:(typical culture positive SBP n=14)
Group 1B:( culture negative SBP n=6)
Group 2: include 20 patients with sterile ascites .
Group 3: include 20 patients with liver cirrhosis without ascites .
these groups were compared in terms of serum IL22 levels in predicting ascites infection.
Patients were subjected to thorough history taking, completeclinical examination and to laboratory tests: complete blood count, urine analysis, stool analysis, bilirubin (total anddirect), total protein, albumin, AST, ALT,prothrombin time, prothrombin concentration, international normalized ratio (INR), urea, creatinine, random bloodglucose, viral markers: Hepatitis B Surface Antigen (HBs-Ag), Hepatitis C Virus Anti-body (HCV-Ab), erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP), alpha feto protein , ferritin, Serum ceruloplasmin,ascetic fluid analyses. Abdominal ultrasound and ECHO-heart ..
Receiver operating characteristic (ROC) curves were used to evaluate
the diagnostic performance of serum IL22 levels and predicting outcome of IL22 levelswas compared with C-reactive protein (CRP) ,Total Leucocytic count (TLC) and Erythrocyte Sedimentation Rate (ESR) .
We found that:
-Serum IL22 levels were determined to be significantly higher in patients with SBP than IL22 levels inpatients with sterile ascites.
However, despite the use of sensitive methods, ascites culture has been negative in as many as 60% of patients with clinicalmanifestations suggestive of SBP and increased ascites neutrophil count. In this regard, given that the crucial role of requiring prompt recognition and treatment, in all the available guidelines, diagnosis has been based on a fixed defined cut-off PMN count in the ascitic fluid with the greatest sensitivity is reached at a cut-off value of 250 PMN/mm3.
Nonetheless, in the emergency setting, performing ascitic fluid culture examination is time consuming and not always available indicating the need for easy to apply, rapid and reliable markers to predict diagnosis in patients with ascites.
Interleukin 22 (IL-22) was originally identified as an IL-10-related T cell-derived inducible factor (IL-TIF), belonging to IL-10 family. IL-22 mainly targets epithelial cells including hepatocytes, playing an important role in controlling bacterial infection, homeostasis, and tissue repair.
IL-22 is a well-documented antioxidant factor for hepatocytes via the upregulation of anti-oxidative genes (e.g., metallothioneins 1 and 2) . Finally, IL-22 has a potent antiapoptotic, anti-steatotic, antifungal , and antimicrobial effects .
In the cirrhotic liver,IL22 may be secreted to protect residual healthy livertissue. Assuming that IL-22 possesses hepatoprotectiveproperties in end-stage liver disease, IL-22 may be a relevantfactor for progression of liver cirrhosis and developmentof hepaticcomplications as spontaneous bacterial peritonitis (SBP) .
Aim:To evaluate the role of serum Interleukin-22levels in predicting spontaneous bacterial peritonitisin hepatitis C virus related liver disease.
Patients and Methods: This study was conducted on 60 patients from January 2014 to February 2015 admitted at the internal medicine department of Suez health insurance hospital suffering from Hepatitis C virus induced liver cirrhosis and ascitic fluid infection.
The patients were classified according to presence and/or sterility of ascitic fluid at time of admission into 3 groups:
Group 1:(combination group: typical culture positive SBP and culture negative SBP n=20) Then group1(combination group) was subdivided into:Group 1A:(typical culture positive SBP n=14)
Group 1B:( culture negative SBP n=6)
Group 2: include 20 patients with sterile ascites .
Group 3: include 20 patients with liver cirrhosis without ascites .
these groups were compared in terms of serum IL22 levels in predicting ascites infection.
Patients were subjected to thorough history taking, completeclinical examination and to laboratory tests: complete blood count, urine analysis, stool analysis, bilirubin (total anddirect), total protein, albumin, AST, ALT,prothrombin time, prothrombin concentration, international normalized ratio (INR), urea, creatinine, random bloodglucose, viral markers: Hepatitis B Surface Antigen (HBs-Ag), Hepatitis C Virus Anti-body (HCV-Ab), erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP), alpha feto protein , ferritin, Serum ceruloplasmin,ascetic fluid analyses. Abdominal ultrasound and ECHO-heart ..
Receiver operating characteristic (ROC) curves were used to evaluate
the diagnostic performance of serum IL22 levels and predicting outcome of IL22 levelswas compared with C-reactive protein (CRP) ,Total Leucocytic count (TLC) and Erythrocyte Sedimentation Rate (ESR) .
We found that:
-Serum IL22 levels were determined to be significantly higher in patients with SBP than IL22 levels inpatients with sterile ascites.
Other data
| Title | The Role of Serum Interleukin 22 Levels in Predictingspontaneous bacterial peritonitis inpatientswith hepatitis C virus induced liverCirrhosis | Other Titles | تقييم مستوى الانترليوكين22بمصل الدم فى التنبؤ بحدوث الالتهاب البريتونى البكتيرى التلقائى فى مرضى التليف الكبدى الناتج عن الاصابة بفيروس (سى) | Authors | Mohammed Ahmed Abd El waheb | Issue Date | 2015 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G12082.pdf | 683.3 kB | Adobe PDF | View/Open |
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